3/31/2024 Representing People with Dementia: A Practical Guide for Criminal Defense LawyersRead NowThis excerpt is taken from a chapter on Testing by Margaret S. Russell, Esq. and Dr. Robert Ouauo in Representing People with Dementia: A Practical Guide for Criminal Defense Lawyers, Elizabeth Kelley, ed. The number of older adults in the United States is rising, as is the incidence of dementia. As a result, older adults are more likely to come into contact with the justice system, and individuals with dementia are appearing in courts at an unprecedented rate. One out of every eight Americans 65 years or older has diminished mental capacity, as well as one out of every four over age 75, and one out of every two over age 85. Recognition and diagnosis of dementia could impact all phases of criminal litigation. In criminal practice, dementia is raised in conjunction with a defendant’s competency or to prove that a defendant is not guilty by reason of mental defect. It may also come into play in the selection of witnesses, the assessment of victims’ claims, and sentencing considerations. Due to cost and/or time concerns, dementia is often raised and diagnosed in error after quick screening procedures, rather than a full multifactorial investigation. As a result, legal practitioners must understand the basis of dementia diagnosis and be diligent in probing the methods used to diagnose and establish dementia in a court of law. A full multifactorial diagnosis, including medical, neurological, and neuropsychological evaluation, scans, and even genetic testing, should be used to diagnose and establish dementia in a criminal court of law. Medical Testing: A variety of laboratory tests might be used to help diagnose dementia or rule out other conditions. These tests can include hypertension, cholesterol, blood count, drug and alcohol toxicology screens, cerebrospinal fluid analysis (spinal tap), and analysis of thyroid functions. Other tests that might improve the accuracy of a dementia diagnosis include tests for kidney, liver, or blood glucose problems; B12 level; and tests for HIV and syphilis – infections known to cause dementia. In the context of one’s personal and medical history, the overall cognitive profile and pattern of relative strengths and weaknesses can help determine the presence of cognitive dysfunction and which brain systems may be implicated. At a minimum, a mental health evaluation of competence to proceed should include a review of the defendant’s history, current functioning, and understanding of the impending execution and the reasons for it. Neuropsychological Testing: There is considerable clinical as well as biological variability that occurs in different dementing illnesses. Neuropsychological testing can be an important part of the differential diagnostic process in dementia. Standardized tests offer an opportunity to detect subtle cognitive abnormalities and differentiate dementia from normal aging. Neuropsychological examinations can also help differentiate dementia syndromes such as Alzheimer’s disease from cognitive impairment associated with psychiatric disorders, such as depression. Additionally, neuropsychological testing is more sensitive to identifying dementia disorders than cognitive screening. Regardless, even with the most sophisticated evaluations, it will not be clear in many individuals’ first examination whether a small degree of cognitive impairment represents a change consistent with dementia, so follow-up examinations are commonly needed to track progression Brain Scans: Brain scans may be used to identify strokes, tumors, or other conditions that can cause dementia. Degeneration of the brain’s cortex (outer layer) or “cortical atrophy,” common in many forms of dementia, can be visible on a brain scan. The brain cortex normally appears wrinkled, with ridges (called gyri) and grooves (called sulci) in brain tissue. In individuals with cortical atrophy, the progressive loss of neurons causes the ridges to become thinner and the grooves to grow wider. As brain cells die, the ventricles (or fluid-filled cavities in the middle of the brain) expand to fill the available space, becoming much larger than normal. Brain scans identify these changes in the brain’s structure that suggest Alzheimer’s disease and other types of dementia. Genetic Testing Research on genetic predispositions of dementia is rapidly developing. It has been established that there is a link between the APOE allele and its variants and both increased and decreased risk of developing Alzheimer’s kel51328_RepresentingDementia.indb 62 10/28/22 9:50 AM Chapter 5 • Testing 63 disease. (See Liu et al., Apolipoprotein E and Alzheimer Disease: Risk, Mechanisms, and Therapy (2013)). Genetic testing in dementia diagnosis is both novel and rapidly developing.
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2/29/2024 Eliminating Discriminatory Practices Against the Mentally Ill in the Criminal Justice SystemRead Now
It is essential to recognize that mental illness is a medical condition and not a choice. Stigmatizing those with mental illness only creates a culture where they are seen as “less than” and unsupported. By eliminating mental health stigmas in the criminal justice system, we can better support and rehabilitate those who need it. Furthermore, we can change the negative stigma surrounding mental illness and recognize that there is no shame in seeking treatment. Reasonable Accommodations: How Providing Proper Treatment and Support Leads to Better Outcomes By providing reasonable accommodations for those with mental illness, we can create better outcomes for both the individual and society. This can include access to mental health treatment, medications, and therapy that are often absent in the criminal justice system. These accommodations can provide a significant impact and help individuals with mental illness recover so they can become functioning members of society. Understanding vs Punishment: Diagnosing and Treating Mental Illness Instead of Incarcerating It is crucial that we change our approach from punishment to understanding and treatment. Instead of incarcerating those with mental illness, we should be creating a system that diagnoses and provides appropriate treatment and support. When we understand and treat mental illness, we are more likely to prevent criminal behavior and help the individual lead a fulfilling life. Disabilities Rights We must recognize that those with mental illness should be afforded the same rights and protections as any other individual. By leveraging the Americans with Disabilities Act (ADA) and disability rights, we can create meaningful reforms in the criminal justice system. This can include ensuring that accommodations are provided, mental health services are available, and appropriate support is given. It's Time for Change Eliminating discriminatory practices against the mentally ill in the criminal justice system is long overdue. If we continue to ignore this issue, we are not only hurting individuals with mental illness, but we are also perpetuating systemic problems that create a cycle of harm. It is time for a comprehensive approach that values rehabilitation and understanding rather than punishment. As a society, we need to prioritize the mental health of our citizens, especially those in the criminal justice system. Only then can we create a more compassionate and effective system. If you or a loved one has a mental disability and has been arrested or convicted of a crime, you need an experienced criminal defense attorney on your side. Elizabeth Kelley specializes in representing individuals with mental disabilities. To schedule a consultation call (509) 991-7058. Mental illness is not a crime, but too often, individuals with mental health conditions end up in the criminal justice system. The reasons are varied, but stigma and a lack of access to healthcare are common contributors. This article will explore the ways we can work towards breaking down the stigma of mental illness in the context of the criminal justice system. Recognizing the Signs People with mental health conditions can often be misunderstood, and their behavior is often misinterpreted. Common mental illnesses like bipolar disorder, schizophrenia, and schizo-affective disorder can all contribute to behavior that law enforcement officers may perceive as dangerous or threatening. It's essential to recognize the signs that an individual may be struggling with a mental health issue. Frequently, these signs can include erratic behavior, extreme emotions, and agitation. Fighting Prejudice The first step to breaking the stigma surrounding mental illness is to dispel common myths and misconceptions about those who struggle with their mental health. Some of these myths include that people with mental health conditions are violent or unstable. The sad truth is that individuals with mental health conditions are more likely to be victims of violence than to perpetrate violence. It's important to recognize that everyone can be affected by mental illness. Getting to the Root Cause Many factors contribute to mental health issues. Stress, trauma, and poverty can all increase the likelihood of developing a mental health condition. Unfortunately, individuals who experience these factors are also more likely to have contact with the criminal justice system. Improving access to healthcare and mental health services is vital in addressing these issues. Improving Police Response Crisis Intervention Training (CIT) is one way to improve police response when dealing with individuals in a mental health crisis. This type of training teaches officers how to de-escalate situations without resorting to violence. Additionally, having access to alternative resources like mobile crisis teams or mental health professionals can help individuals receive the appropriate care they need, rather than just ending up in jail. Changing the Conversation It's essential to shift the narrative surrounding mental illness to one of empathy and understanding. Education plays a vital role in breaking down stigma. By educating our communities about mental health conditions and working to destigmatize them, we can create safer and more compassionate communities. If you or a loved one has a mental disability and has been arrested or convicted of a crime, you need an experienced criminal defense attorney on your side. Elizabeth Kelley specializes in representing individuals with mental disabilities. To schedule a consultation call (509) 991-7058. Although there have been a number of advances toward acceptance of lesbian, gay, bisexual, transgender and questioning individuals, it is still not easy for LGBTQ youth. In addition to struggling with their own identity, many young people face discrimination and bullying. In its most recent surveyof LGBTQ youth, the Trevor Project found that 40% of respondents said they have seriously considered attempting suicide in the past year. The number is even higher for transgender and nonbinary youth. This is a staggering number and points to a mental health crisis that must be addressed.
Hurdles to Overcome Even with advancements in legislation, policy, and culture, the LGBTQ community still has hurdles to overcome. LGBTQ youth still face discrimination and rejection from their families and the community at large. Add to that the hateful rhetoric that has become increasingly pervasive in recent years, and there is a recipe for disaster. Transgender and nonbinary (people who do not identify as male or female) youth face even greater discrimination and misunderstanding. As a result, LGBTQ youth are more than four times more likely to attempt suicide than their peers. Social media seems to be a mixed bag when it comes to the feelings of rejection for LGBTQ youth. They have become more exposed to hateful rhetoric and rejecting comments. However, many LGBTQ young people feel alone, and being able to make a helpful connection through social media can go a long way toward making someone feel accepted. Addressing the Issue The best way to address the issue of mental health and LGBTQ youth is to provide adequate treatment for these young people. Mental health professionals who specialize in LGBTQ issues are necessary to provide a safe place where young people can feel free to express themselves and their feelings. Providing specialized training to mental health professionals can make this a reality. In addition, LGBTQ community centers can help provide affirming messages of acceptance to young people, which can help change their outlook. If you or someone you know is feeling helpless or suicidal, the Trevor Project has a confidential suicide hotline. The Trevor Lifeline is available 24/7 at 1-866-488-7836. Online counseling is also available at thetrevorproject.org/get-help-now/. If you or a loved one has a mental disability and has been arrested or convicted of a crime, you need an experienced criminal defense attorney on your side. Elizabeth Kelley specializes in representing individuals with mental disabilities. To schedule a consultation call (509) 991-7058. A traumatic brain injury can be life-changing for sufferers in a number of different ways. It can change the way they function and behave, and it can even change their personality. But can traumatic brain injury lead someone to commit a violent crime? Some studies show this may be the case.
What is a Traumatic Brain Injury? A traumatic brain injury (TBI) typically results from a violent jolt or blow to the head. An object, like a bullet, penetrating the skull and brain tissue can also result in a TBI. A mild TBI may affect a person's brain cells temporarily. A more serious TBI can result in torn tissue, bruising, bleeding, and other physical damage to the brain. A serious TBI can result in long-term complications. An estimated 1.7 million people annually sustain a TBI. Linked to Crime? The link between TBI and violent crime is a controversial subject that we are still struggling to understand. A number of studies have found a link between TBI and violence. A 2009 study found an increase in aggression among people who suffered a TBI. This aggression was believed to be linked to a change in psychosocial functioning and changes in personality. Another study found that young people who suffered a recent head injury were more likely to report violent behavior. Aggressive behavior associated with TBI includes explosive outbursts that can be set off with minimal provocation. These outbursts can range in severity for irritability to property damage or assaults on others. Cognitive and behavioral problems associated with TBI can result in aggressive behavior that leads to violence. In addition, a lack of insight and judgment can also lead to behavior in which the person would never have engaged if they did not suffer from a TBI. In fact, these same conditions can also make those with TBIs more likely to be victims of violent crime which can perpetuate the cycle. Violence as both a cause and consequence of TBI is a serious problem that must be addressed. If you or a loved one has a mental disability and has been arrested or convicted of a crime, you need an experienced criminal defense attorney on your side. Elizabeth Kelley specializes in representing individuals with mental disabilities. To schedule a consultation call (509) 991-7058. New York State Bar Association President Henry Greenberg recently announced a call to action to consider removing mental health questions from bar applications. Greenberg noted“time in law school is marked by extreme stress, anxiety, overwhelming expectations, and financial uncertainty. Many students admit they are not seeking help because they are concerned that doing so will negatively impact their bar admission.”
Bar Applications On the current New York State application for admission to the Bar, applicants are asked to disclose information about their mental health status and substance abuse history. The questions are part of the character and fitness section of the application and imply that people with mental health issues are not fit to practice law. An applicant bears the burden of proving that they are fit to practice law. The question asks: “Do you currently have any condition or impairment including, but not limited to a mental, emotional, psychiatric, nervous or behavioral disorder or condition, or an alcohol, drug or other substance abuse condition or impairment or gambling addiction, which in any way impairs or limits your ability to practice law?” In contrast, bar applicants are not asked to disclose any physical illnesses. Removing the Question Currently, 40 states have similar mental health questions on their bar applications. There is a growing movement nationwide to remove these inquiries from the application process. Many law students forgo treatment for mental health conditions because they are afraid of the adverse effect such treatment could have on their admission. According to an American Bar Association survey, almost half of law students suffering from a mental health condition feared that seeking treatment could pose a threat to their bar admission. The New York Unified Court System will review the applications to determine if a change needs to be made to the inquiries. The application is continually updated and revised. Inquiries into the character and fitness of bar applicants should focus more on an individual’s conduct and behavior and less on their mental health treatment. Removing the mental health question could lead to an improvement in law student well-being as more people will feel comfortable accessing treatment. If you or a loved one has a mental disability and has been arrested or convicted of a crime, you need an experienced criminal defense attorney on your side. Elizabeth Kelley specializes in representing individuals with mental disabilities. To schedule a consultation call (509) 991-7058. The mental health of children in California is in crisis. A 2018 reportfrom the California Health Care Foundation noted that an increasing number of teens in the state suffer from major depression. According to the report, in 2015, 1 in 9 teenage girls attempted suicide. The problem is compounded by the fact that people in their teens and early twenties are less likely to receive mental health treatment than other groups. A new bill introduced in the California legislature hopes to provide some help with this crisis.
Senate Bill 12 Senate Bill 12, introduced by Democratic Senators Jim Beall and Anthony Portantino, seeks to create 100 youth drop-in centers across the state that can help support young people with mental health, substance abuse, and physical health issues. The centers would be created under a new initiative called the Integrated Youth Mental Health Program and would provide one-stop support to youth ages 12 to 25 who are too embarrassed or unable to seek help in a traditional school or medical setting. The drop-in centers would be designed in a way that would be inviting to teens and young people. They would provide mental health and substance abuse treatment, as well as educational and vocational support and peer mentoring. The initiative is modeled after similar programs found in Australia and Canada and would be the first of its kind in the United States. The bill requests $200 million in the budget to fund the centers. These funds could be combined with additional funds from the federal government. Senator Beall also introduced a bill to increase mental health services in California schools. However, not all young people want help from their school, or are not in school, so in the drop-in centers are important. The Importance of Mental Health Treatment Mental health issues are likely to first present themselves in people who are in their late teens and early twenties. This is an essential time to link young people with mental health services. Addressing and treating these concerns early can help prevent issues from escalating and becoming more difficult to treat later in life. If you or a loved one has a mental disability and has been arrested or convicted of a crime, you need an experienced criminal defense attorney on your side. Elizabeth Kelley specializes in representing individuals with mental disabilities. To schedule a consultation call (509) 991-7058. The men and women who honorably serve our country are true heroes. However, sometimes, these heroes return home changed people. The stress from the job, along with the difficulty of adjusting to civilian life, can have a serious impact on a veteran's well-being. In some cases, veterans come home with conditions like PTSD and substance abuse issues. A lack of support can place some of these veterans on the wrong side of the law.
Veterans’ Treatment Courts Similar to drug courts and mental health courts, Veterans’ Treatment Courts seek to provide a better option for veterans who have been charged with a crime. The goal of these courts is to help veterans in trouble with the law regain stability, mental health, and sobriety. The courts are a way of diverting veterans from the typical criminal justice system and offer them assistance with the factors that may have led to their crime. Veterans are linked to community-based services to assist with addiction and mental health issues. They are also given access to agencies that specialize in veterans’ affairs. In New York, Veterans' Treatment Courts take a team approach to address the needs of the veterans. Mental health providers, addiction counselors, veteran's affairs agencies, and peer mentors all work together to assist the veterans. Peer mentors are a critical part of the team approach. They are individuals who have military service and work toward helping fellow veterans in the criminal justice system. Veterans' Treatment Courts have been very successful in assisting veterans and preventing recidivism and future involvement with the criminal justice system. Expansion There are currently 33 Veterans’ Treatment Courts throughout the state of New York. These courts have been very successful, but more work needs to be done. There are currently 37 counties in New York that do not have a Veterans’ Treatment Court. Some counties lack the resources to support these courts. New York is now looking to change the law to allow criminal cases involving veterans to be transferred to a Veterans’ Treatment Court in an adjacent county. This could go a long way to helping even more veterans get their lives back on track. If you or a loved one has a mental disability and has been arrested or convicted of a crime, you need an experienced criminal defense attorney on your side. Elizabeth Kelley specializes in representing individuals with mental disabilities. To schedule a consultation call (509) 991-7058. In June of 2019, the Ohio House passed a billthat would end the use of the death penalty on individuals who suffer from severe mental illness. The bill received bipartisan support and is the result of a task force that reviewed the state’s administration of the death penalty.
Severe Mental Illness Under the bill, severe mental illness includes conditions such as schizophrenia, schizoaffective disorder, bipolar disorder, and delusional disorder. If an offender suffers from one of these conditions at the time they committed the crime, they could avoid the death penalty. In Ohio, individuals who commit aggravated murder are subject to the death penalty. If a defendant argues that they suffered from a serious mental illness at the time of the aggravated murder, a court can order a psychological evaluation. If the person is ultimately found guilty of aggravated murder, they may be sentenced to life without parole instead of the death penalty if it is found that they had a serious mental illness at the time. Opposition to the Bill The Ohio Prosecuting Attorneys Association has been opposed to the bill. They believe that there are already safeguards in place to help people with mental illness or developmental disabilities from being subject to the death penalty. They believe that the bill would only help those whose mental illness is so minor that they failed to create reasonable doubt in the minds of a jury that they were not guilty by reason of insanity. Moving Forward The bill is intended to be retroactive. This means that individuals who are currently on death row in Ohio can seek an evaluation regarding their mental health and have their sentence reduced to life without parole. There are currently 142 people on death row in Ohio. Ohio executions are currently on hold as officials search for a new means of administering the death penalty. A federal magistrate ruled that the old three-drug cocktail method was unconstitutional. House Bill 136 now moves to the Ohio Senate for consideration. If you or a loved one has a mental disability and has been arrested or convicted of a crime, you need an experienced criminal defense attorney on your side. Elizabeth Kelley specializes in representing individuals with mental illnesses. To schedule a consultation call (509) 991-7058. All parents get anxious when their teen driver gets behind the wheel. Car accidents are the number onecause of death for teens. However, parents of teens with attention-deficit/hyperactivity disorder (ADHD) may have even more to worry about. A new studyin the Journal Pediatrics found that teen drivers with ADHD have a higher risk of being involved in a crash and are more likely to get traffic tickets.
Higher Risk The study found that in the first month of driving, a teen with ADHD is 62% more likely to be involved in an auto accident than other teen drivers. The study also showed that over the course of four years, teen drivers with ADHD were two times more likely to be involved in an alcohol-related crash than a teen driver without ADHD. It was also discovered that teen drivers with ADHD were more likely to get traffic tickets for infractions such as driving distracted, speeding, and failing to wear a seatbelt. Around 36% of drivers with ADHD received a traffic ticket compared to 25% for drivers without ADHD. Reasons for the Risk There are a number of reasons related to an ADHD diagnosis that can contribute to the increased driving risk. ADHD symptoms include hyperactivity, impulsivity, and issues with attention and focus. As a result, many of the necessary skills needed for safe driving are lacking in teens with ADHD. It is clear that a teen driver with ADHD would be more prone to distraction while driving and would be more likely to engage in risky, impulsive behaviors. Reducing the Risk There may be a need for significant intervention at the driver training stage for teen drivers with ADHD in order to reduce the risk of accidents and tickets. Parents should get involved early and ensure that their teen has plenty of practice behind the wheel. In addition, driver education programs should be modified to emphasize the importance of avoiding distraction and risky behavior. If a teen lacks good judgment and is not mature enough to handle driving, then parents should not be afraid to discourage their teen from driving. In addition, parents can limit distractions by forcing their teen to turn off their cellphone while driving and discourage them from driving with teen passengers, can also help reduce the danger. If you or a loved one has a mental disability and has been arrested or convicted of a crime, you need an experienced criminal defense attorney on your side. Elizabeth Kelley specializes in representing individuals with mental illnesses. To schedule a consultation call (509) 991-7058. |
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